The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review.
Antibiotic resistance
Conflict-affected
Cost of illness
Multi-drug resistance
Refugee
Socioeconomic
Journal
Conflict and health
ISSN: 1752-1505
Titre abrégé: Confl Health
Pays: England
ID NLM: 101286573
Informations de publication
Date de publication:
06 Apr 2021
06 Apr 2021
Historique:
received:
14
09
2020
accepted:
18
03
2021
entrez:
7
4
2021
pubmed:
8
4
2021
medline:
8
4
2021
Statut:
epublish
Résumé
Antibiotic resistance (ABR) is a major global threat. Armed and protracted conflicts act as multipliers of infection and ABR, thus leading to increased healthcare and societal costs. We aimed to understand and describe the socioeconomic burden of ABR in conflict-affected settings and refugee hosting countries by conducting a systematic scoping review. A systematic search of PubMed, Medline (Ovid), Embase, Web of Science, SCOPUS and Open Grey databases was conducted to identify all relevant human studies published between January 1990 and August 2019. An updated search was also conducted in April 2020 using Medline/Ovid. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. The Newcastle-Ottawa Scale was used to assess study quality. Data extraction and analysis were based on the PICOS framework and following the PRISMA-ScR guideline. The search yielded 8 studies (7 publications), most of which were single-country, mono-center and retrospective studies. The studies were conducted in Lebanon (n = 3), Iraq (n = 2), Jordan (n = 1), Palestine (n = 1) and Yemen (n = 1). Most of the studies did not have a primary aim to assess the socioeconomic impact of ABR and were small studies with limited statistical power that could not demonstrate significant associations. The included studies lacked sufficient information for the accurate evaluation of the cost incurred by antibiotic resistant infections in conflict-affected countries. This review highlights the scarcity of research on the socioeconomic burden of ABR on general populations in conflict-affected settings and on refugees and migrants in host countries, and lists recommendations for consideration in future studies. Further studies are needed to understand the cost of ABR in these settings to develop and implement adaptable policies.
Sections du résumé
BACKGROUND
BACKGROUND
Antibiotic resistance (ABR) is a major global threat. Armed and protracted conflicts act as multipliers of infection and ABR, thus leading to increased healthcare and societal costs. We aimed to understand and describe the socioeconomic burden of ABR in conflict-affected settings and refugee hosting countries by conducting a systematic scoping review.
METHODS
METHODS
A systematic search of PubMed, Medline (Ovid), Embase, Web of Science, SCOPUS and Open Grey databases was conducted to identify all relevant human studies published between January 1990 and August 2019. An updated search was also conducted in April 2020 using Medline/Ovid. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. The Newcastle-Ottawa Scale was used to assess study quality. Data extraction and analysis were based on the PICOS framework and following the PRISMA-ScR guideline.
RESULTS
RESULTS
The search yielded 8 studies (7 publications), most of which were single-country, mono-center and retrospective studies. The studies were conducted in Lebanon (n = 3), Iraq (n = 2), Jordan (n = 1), Palestine (n = 1) and Yemen (n = 1). Most of the studies did not have a primary aim to assess the socioeconomic impact of ABR and were small studies with limited statistical power that could not demonstrate significant associations. The included studies lacked sufficient information for the accurate evaluation of the cost incurred by antibiotic resistant infections in conflict-affected countries.
CONCLUSION
CONCLUSIONS
This review highlights the scarcity of research on the socioeconomic burden of ABR on general populations in conflict-affected settings and on refugees and migrants in host countries, and lists recommendations for consideration in future studies. Further studies are needed to understand the cost of ABR in these settings to develop and implement adaptable policies.
Identifiants
pubmed: 33823882
doi: 10.1186/s13031-021-00357-6
pii: 10.1186/s13031-021-00357-6
pmc: PMC8025481
doi:
Types de publication
Journal Article
Langues
eng
Pagination
21Références
World Health Organization. Antimicrobial resistance 2018 [cited 2019 2019/05/30]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance .
Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. 2013 [cited 2020 22 April, 2020]. Available from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf .
European Centers for Disease Control and Prevention. Antimicrobial resistance: trackling the burden in the European Union. 2019. [cited 2020 22 April, 2020]. Available from: https://www.oecd.org/health/health-systems/AMR-Tackling-the-Burden-in-the-EU-OECD-ECDC-Briefing-Note-2019.pdf .
World Health Organization. Health financing policy and implementation in fragile and conflict-affected settings: Synthesis of evidence and policy recommendations. 2019 Contract No.: WHO/HIS/HGF/HFGuidance/19.7.
Lafta R, Al-Shatari S, Cherewick M, Galway L, Mock C, Hagopian A, et al. Injuries, death, and disability associated with 11 years of conflict in Baghdad, Iraq: a randomized household cluster survey. PLoS One. 2015;10(8):e0131834. https://doi.org/10.1371/journal.pone.0131834 .
doi: 10.1371/journal.pone.0131834
pubmed: 26252879
pmcid: 4529175
Vella MA, Warshauer A, Tortorello G, Fernandez-Moure J, Giacolone J, Chen B, et al. Long-term functional, psychological, emotional, and social outcomes in survivors of firearm injuries. JAMA Surg. 2020;155(1):51–9. https://doi.org/10.1001/jamasurg.2019.4533 .
doi: 10.1001/jamasurg.2019.4533
pubmed: 31746949
Edwards DS, Phillip RD, Bosanquet N, Bull AMJ, Clasper JC. What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort? Clinical Orthopaedics and Related Research®. 2015;473(9):2848–55.
doi: 10.1007/s11999-015-4250-9
Zuraik C, Sampalis J, Brierre A. The economic and social burden of traumatic injuries: evidence from a trauma Hospital in Port-au-Prince, Haiti. World J Surg. 2018;42(6):1639–46. https://doi.org/10.1007/s00268-017-4360-5 .
doi: 10.1007/s00268-017-4360-5
pubmed: 29164295
Sahli ZT, Bizri AR, Abu-Sittah GS. Microbiology and risk factors associated with war-related wound infections in the Middle East. Epidemiol Infect. 2016;144(13):2848–57. https://doi.org/10.1017/S0950268816000431 .
doi: 10.1017/S0950268816000431
pubmed: 26931769
Gandra S, Barter DM, Laxminarayan R. Economic burden of antibiotic resistance: how much do we really know? Clin Microbiol Infect. 2014;20(10):973–80. https://doi.org/10.1111/1469-0691.12798 .
doi: 10.1111/1469-0691.12798
pubmed: 25273968
Debarre A. Hard to reach: providing healthcare in armed conflict. International peace institute., December 2018. Report No.
Bantar C, Sartori B, Vesco E, Heft C, Saúl M, Salamone F, et al. A Hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis. 2003;37(2):180–6. https://doi.org/10.1086/375818 .
doi: 10.1086/375818
pubmed: 12856209
Alsan M, Schoemaker L, Eggleston K, Kammili N, Kolli P, Bhattacharya J. Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis. Lancet Infect Dis. 2015;15(10):1203–10. https://doi.org/10.1016/S1473-3099(15)00149-8 .
doi: 10.1016/S1473-3099(15)00149-8
pubmed: 26164481
pmcid: 4609169
Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS ONE [Electronic Resource]. 2017;12(12):e0189621.
doi: 10.1371/journal.pone.0189621
Nathwani D, Raman G, Sulham K, Gavaghan M, Menon V. Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: A systematic review and meta-analysis. Antimicrobial Resistance and Infection Control. 2014;3:1.
doi: 10.1186/2047-2994-3-32
Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrobial Resistance Infection Control. 2019;8(1):35. https://doi.org/10.1186/s13756-019-0471-0 .
doi: 10.1186/s13756-019-0471-0
pubmed: 30805182
pmcid: 6373132
Zhen X, Lundborg CS, Sun X, Hu X, Dong H. Economic burden of antibiotic resistance in ESKAPE organisms: A systematic review. Antimicrobial Resistance and Infection Control. 2019;8(1).
Naylor NR, Atun R, Zhu N, Kulasabanathan K, Silva S, Chatterjee A, et al. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrobial Resistance Infection Control. 2018;7(1):58. https://doi.org/10.1186/s13756-018-0336-y .
doi: 10.1186/s13756-018-0336-y
pubmed: 29713465
pmcid: 5918775
Fragile and conflict affected situations: The World Bank [cited 2019 November 6, 2019]. Available from: https://data.worldbank.org/region/fragile-and-conflict-affected-situations .
Low & middle income: The World Bank [cited 2019 November 6, 2019]. Available from: https://data.worldbank.org/income-level/low-and-middle-income .
Choi H-J, Lee E-W. Methodology of Estimating Socioeconomic Burden of Disease Using National Health Insurance (NHI) Data. 2019. In: evaluation of health services [internet]. IntechOpen. Available from: https://www.intechopen.com/books/evaluation-of-health-services/methodology-of-estimating-socioeconomic-burden-of-disease-using-national-health-insurance-nhi-data .
Kanafani ZA, Zahreddine N, Tayyar R, Sfeir J, Araj GF, Matar GM, et al. Multi-drug resistant Acinetobacter species: a seven-year experience from a tertiary care center in Lebanon. Antimicrob Resist Infect Control. 2018;7(1):9. https://doi.org/10.1186/s13756-017-0297-6 .
doi: 10.1186/s13756-017-0297-6
pubmed: 29387343
pmcid: 5778738
Matar MJ, Moghnieh R, Alothman AF, Althaqafi AO, Alenazi TH, Farahat FM, et al. Treatment patterns, resource utilization, and outcomes among hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections in Lebanon and Saudi Arabia. Infection Drug Resistance. 2017;10:43–8. https://doi.org/10.2147/IDR.S97415 .
doi: 10.2147/IDR.S97415
pubmed: 28706447
pmcid: 5495009
Aldous WK, Co EM. Factors associated with recovery of multidrug-resistant bacteria in a combat support hospital in Iraq. Infection Control Hospital Epidemiology. 2010;31(4):425–7. https://doi.org/10.1086/651302 .
doi: 10.1086/651302
pubmed: 20184421
Babakir-Mina M, Othman N, Najmuldeen HH, Noori CK, Fatah CF, Perno CF, et al. Antibiotic susceptibility of vancomyin and nitrofurantoin in Staphylococcus aureus isolated from burnt patients in Sulaimaniyah, Iraqi Kurdistan. New Microbiologica. 2012;35(4):439–46.
pubmed: 23109011
Alga A, Wong S, Shoaib M, Lundgren K, Giske CG, von Schreeb J, et al. Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan. BMC Infect Dis. 2018;18(1):233. https://doi.org/10.1186/s12879-018-3149-y .
doi: 10.1186/s12879-018-3149-y
pubmed: 29788910
pmcid: 5964734
Al Jarousha AM, El Jadba AH, Al Afifi AS, El Qouqa IA. Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis. 2009;13(5):623–8. https://doi.org/10.1016/j.ijid.2008.08.029 .
doi: 10.1016/j.ijid.2008.08.029
pubmed: 19144555
Nasher S, Alsharapy S, Al-Madhagi A, Zakham F. Epidemiology of extended-spectrum beta-lactamase producing Escherichia coli from hospital settings in Yemen. J Infection Developing Countries. 2018;12(11):953–9. https://doi.org/10.3855/jidc.10560 .
doi: 10.3855/jidc.10560
Roberts RR, Scott RD 2nd, Hota B, Kampe LM, Abbasi F, Schabowski S, et al. Costs attributable to healthcare-acquired infection in hospitalized adults and a comparison of economic methods. Med Care. 2010;48(11):1026–35. https://doi.org/10.1097/MLR.0b013e3181ef60a2 .
doi: 10.1097/MLR.0b013e3181ef60a2
pubmed: 20940650
Cheah AL, Spelman T, Liew D, Peel T, Howden BP, Spelman D, et al. Enterococcal bacteraemia: factors influencing mortality, length of stay and costs of hospitalization. Clin Microbiol Infect. 2013;19(4):E181–9. https://doi.org/10.1111/1469-0691.12132 .
doi: 10.1111/1469-0691.12132
pubmed: 23398607
Anderson M, Cecchini M, Mossialos E, North J. Challenges to tackling antimicrobial resistance: economic and policy responses: Cambridge University press; 2020. https://doi.org/10.1017/9781108864121 .
doi: 10.1017/9781108864121
Strategic Research and Innovation Agenda on Antimicrobial Resistance. Stockholm: Joint Programming Initiative on Antimicrobial Resistance 2019.
Soule BM, Memish ZA, Malani PN. Best practices in infection prevention and control: an international perspective: joint commission international; 2012.
Haraoui LP, Sparrow A, Sullivan R, Burci GL, Dewachi O, Abu-Sittah G, et al. Armed conflicts and antimicrobial resistance: a deadly convergence. AMR Control; 2019. p. 69–73.
Bunduki GK, Katembo J-LM, Kamwira IS. Antimicrobial resistance in a war-torn country: lessons learned in the eastern Democratic Republic of the Congo. One Health. 2020;9:100120. https://doi.org/10.1016/j.onehlt.2019.100120 .
doi: 10.1016/j.onehlt.2019.100120
pubmed: 32368609
Lomazzi M, Moore M, Johnson A, Balasegaram M, Borisch B. Antimicrobial resistance – moving forward? BMC Public Health. 2019;19(1):858. https://doi.org/10.1186/s12889-019-7173-7 .
doi: 10.1186/s12889-019-7173-7
pubmed: 31266477
pmcid: 6604320
El Achi N, Papamichail A, Rizk A, Lindsay H, Menassa M, Abdul-Khalek RA, et al. A conceptual framework for capacity strengthening of health research in conflict: the case of the Middle East and North Africa region. Glob Health. 2019;15(1):81. https://doi.org/10.1186/s12992-019-0525-3 .
doi: 10.1186/s12992-019-0525-3